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Wisconsin rates for HCPCS 54901

Epididymovasostomy Anast Epididymis Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.42 / $2,165.21 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.93 / $1,135.42 / $3,484.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,060.00 / $7,344.00 / $10,517.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.24 / $2,726.02 / $5,966.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,717.78 / $3,175.94 / $5,122.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.86 / $3,288.12 / $4,349.42
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.42 / $1,453.54 / $5,306.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.42 / $5,080.00 / $8,783.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.82 / $2,533.41 / $5,575.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $849.90 / $2,222.04
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,058.55 / $1,453.54 / $5,306.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,063.10 / $3,185.74 / $3,752.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,388.90 / $9,388.90 / $9,388.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,465.29 / $5,159.55 / $8,061.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,880.21 / $2,880.21 / $2,880.21
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,029.38 / $5,090.68 / $5,090.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.48 / $3,153.03 / $4,890.68